Percutaneous right ventricular assist apparatus and method

ABSTRACT

A system for assisting the right heart of a patient includes a PA cannula adapted for insertion into a PA of a patient through the right internal jugular vein of the patient. The system includes a percutaneous RA cannula adapted for insertion into an RA of the patient. The system includes a blood pump disposed outside of the patient to which the RA cannula and the PA cannula are connected to provide right ventricular circulatory support to the patient without any left ventricular assist. A method for assisting the right heart of a patient includes the steps of inserting a PA cannula into a PA of a patient. There is the step of inserting an RA cannula into an RA of the patient. There is the step of connecting the RA cannula and the PA cannula to a blood pump disposed outside of the patient. There is the step of activating the blood pump to provide right ventricular circulatory support to assist the heart of the patient.

CROSS REFERENCE TO RELATED APPLICATIONS

This application claims the benefit of U.S. patent application Ser. No.11/328,961, filed Jan. 6, 2006 and titled Percutaneous Right VentricularAssist Apparatus and Method.

FIELD OF THE INVENTION

The present invention is related to right ventricular assist. Morespecifically, the present invention is related to right ventricularassist without any left ventricular assist and without any open chestsurgery.

BACKGROUND OF THE INVENTION

Right ventricular (RV) failure is known to occur in 10-15% of patientsfollowing left ventricular assist device (LVAD) placement. In addition,acute RV failure following orthotopic cardiac transplantation is alsoknown to occur, and may be related to RV stunning at the time of organharvest and administration of cardioplegia. RV failure in these settingsis often reversible, not requiring long term mechanical support.Currently, commercially available devices approved for RV assist involvethe surgical placement of either centrifugal or pulsatile devices, allof which require surgical operation for both placement and deviceremoval. A percutaneously placed right ventricular assist device, ifavailable, could spare patients the risk resulting from generalanesthesia and open heart operation.

The current TandemHeart PTVA system is a percutaneous left ventricularassist system comprised of a centrifugal pump, a 21 Fr, .about.65 cmlong uptake cannula designed to be placed across the interatrial septumusing standard transseptal puncture technique, and a 15 or 17 Fr returncannula; with the cannulae connected to the pump using standard ⅜ inchsurgical tubing. Systemic flow rates of 3.5-4.0 Liters/Min. can beachieved. This device has been studied on acute cardiogenic shockpatients and was found to confer a significant hemodynamic benefitcompared to the intraaortic balloon pump (IABP). It is currentlyapproved by the FDA for temporary (<6 hr) left ventricular mechanicalcirculatory support, and based on the results of the cardiogenic shocktrial, will likely receive an FDA approved indication in the setting ofacute cardiogenic shock due to left heart failure.

There are three previous publications on the topic of percutaneous rightventricular assistance. Two are by Yano (Trans Am Soc Artif Organs 1993;39:120-25, Ann Thorac Surg 1996; 61:1231-35). These report on the samework, one preliminary and the other with more data. The third is fromMatsuo with Yano as the second author (Artif Organs 2000; 24:148-55).This is from the same group and is very similar to the other tworeports.

These papers report the results of right ventricular assistance inexperimental animals, using custom designed cannulae and off the shelfcentrifugal pumps. The cannulae are prototypes and not available on thecommercial market. The pumps are commercially available devices,typically used for cardiopulmonary bypass. These pumps are forshort-term use during surgery and should not be considered asventricular assist devices. In all of the experiments, the right-sideassistance was used in conjunction with left side support. The originalpaper was in 1993 and it has not been applied in a patient by thisgroup.

SUMMARY OF THE INVENTION

The present invention pertains to a system for assisting the right heartof a patient. The system comprises a PA (Pulmonary Artery) cannulaadapted for insertion into a PA of a patient through the right internaljugular (RIJ) vein of the patient. The system comprises a percutaneousRA cannula adapted for insertion into an RA (Right Atrium) of thepatient. The system comprises a blood pump disposed outside of thepatient to which the RA cannula and the PA cannula are connected toprovide right ventricular circulatory support to the patient without anyleft ventricular assist.

The present invention pertains to a method for assisting the right heartof a patient. The method comprises the step of inserting a PA cannulainto a PA of a patient. There is the step of inserting an RA cannulainto an RA of the patient. There is the step of connecting the RAcannula and the PA cannula to a blood pump disposed outside of thepatient. There is the step of activating the blood pump to provide rightventricular circulatory support to assist the heart of the patient.

The present invention provides a means of right heart support withoutsurgery. Placement of the device is accomplished percutaneously. Apercutaneous intake cannula is placed in the patient's RA via RFV (RightFemoral Vein) and is connected to a blood pump outside of the body.Blood is pumped back to the PA through an outflow cannula placed in RIJ.The right ventricle is totally bypassed. No open chest surgery isnecessary.

BRIEF DESCRIPTION OF THE DRAWINGS

In the accompanying drawings, the preferred embodiment of the inventionand preferred methods of practicing the invention are illustrated inwhich:

FIG. 1 is a schematic representation of a right internal jugular veinpunctured with a needle. The wire is then advanced into the rightatrium.

FIG. 2 is a schematic representation of a 17 Fr wire-reinforced cannulaand introducer advanced into the right atrium after dilating the skinsite and the vein.

FIG. 3 is a schematic representation of the 17 Fr cannula in the rightatrium.

FIG. 4 is a schematic representation of a 7 Fr Swan-Ganz catheter thathas passed through the cannula and floated into the right pulmonaryartery.

FIG. 5 is a schematic representation of a super-stiff wire passedthrough the Swan-Ganz catheter to stiffen it.

FIG. 6 is a schematic representation of the 17 Fr cannula advanced overthe Swan-Ganz catheter until it sits in the distal main pulmonaryartery. The Swan-Ganz catheter and the wire are removed, leaving thecannula in position.

FIG. 7 is a schematic representation of the 21 Fr venous drainagecannula advanced from the femoral vein over a wire, using the Seldingertechnique.

FIG. 8 is a schematic representation of the 21 Fr venous drainagecannula positioned in the right atrium and the 17 Fr return cannula inthe main pulmonary artery.

FIG. 9 is a schematic representation of the system of the presentinvention.

DETAILED DESCRIPTION

Referring now to the drawings wherein like reference numerals refer tosimilar or identical parts throughout the several views, and morespecifically to FIG. 9 thereof, there is shown a system 10 for assistingthe right heart of a patient. The system 10 comprises a PA cannula 12adapted for insertion into a PA (pulmonary artery) of a patient throughthe right internal jugular vein of the patient. The system 10 comprisesa percutaneous RA cannula 14 adapted for insertion into an RA of thepatient. The system 10 comprises a blood pump disposed outside of thepatient to which the RA cannula and the PA cannula 12 are connected toprovide right ventricular circulatory support to the patient without anyleft ventricular assist. Preferably, the pump is a ventricular assistpump.

The present invention pertains to a method for assisting the right heartof a patient. The method comprises the steps of inserting a PA cannula12 into a PA of a patient. There is the step of inserting an RA cannula14 into an RA of the patient. There is the step of connecting the RAcannula 14 and the PA cannula 12 to a blood pump disposed outside of thepatient. There is the step of activating the blood pump to provide rightventricular circulatory support to assist the right heart of thepatient.

Preferably, the activating step includes the step of providing flow fromthe blood pump for right ventricular assist of the patient at a levelwhich is ½ to ⅔ of normal cardiac output flow of the patient. Theactivating step preferably includes the step of providing only rightventricular assist with the blood pump to the patient without any leftventricular assist. Preferably, the inserting the PA cannula 12 stepincludes the step of passing a Swan-Ganz catheter through the cannula,floating it into the pulmonary artery, and advancing a super stiff wirethrough a pulmonary artery port of the Swan-Ganz catheter.

The PA cannula 12 preferably has an end hole 22 and at least two sideholes 22 which allow blood flow to the left and right lungs of thepatient, without promoting backflow into the right ventricle of thepatient. Preferably, no open chest surgery occurs. The inserting the RAcannula 14 step preferably includes the step of inserting the RA cannula14 percutaneously into the RA of the patient. Preferably, the rightventricle of the patient is totally bypassed. The activating steppreferably includes the step of pumping unoxygenated blood from theright atrium with the blood pump through the percutaneous RA cannula 14and returning the blood to the pulmonary artery through the PA cannula.

Preferably, the pumping step includes the step of controlling the pumpwith a controller 18 in communication with the pump which detects andmanages faults and produces an alert signal in response to a detectedfault. There is preferably the step of placing the pump in a holder 20that attaches to the lower body of the patient. Preferably, there is thestep of sewing the PA cannula 12 and the RA cannula 14 to the patient.The inserting the PA cannula 12 step preferably includes the step ofinserting the PA cannula 12 through the right internal jugular vein ofthe patient. Preferably, the inserting the PA cannula 12 step includesthe step of removing the Swan-Ganz catheter and the wire from thepatient once the PA cannula 12 is in the patient.

The inserting the RA cannula 14 step preferably includes the step ofinserting the RA cannula 14 into a peripheral vein of the patient over along wire which has been placed in the RA using Seldinger technique. Theinserting the RA cannula 14 step preferably includes the step ofadvancing the RA cannula 14 along the long wire into the RA and removingthe long wire. Preferably, the activating step includes the step ofstarting 2 L/min flow for at least two minutes and then adjusting theflow based on the patient's requirements. There is preferably the stepof using imaging guidance when the RA cannula 14 and the PA cannula 12are placed in the RA and PA, respectively.

In the operation of the preferred embodiment, the system 10 comprises ablood pump, connected to a percutaneous RA cannula 14 at the pump inlet,for pumping unoxygenated blood from the right atrium through the RAcannula 14 and returning the blood to the pulmonary artery through thePA cannula. The blood pump is controlled by a controller 18 thatmonitors key system 10 operating parameters to detect and manage faultsand to alert operators.

The pump 16 and controller 18 operation will be the same as described inU.S. Pat. No. 6,808,508, incorporated by reference herein.

Preferably, the system 10 includes a holder 20 which holds the bloodpump in place. The holding mechanism preferably attaches to thepatient's lower body. One important feature of the holder 20 is tomaintain the position of the pump relative to the cannulae. Since thecannulae are in the patient, it is therefore a general rule that theposition of the pump is maintained relative to the patient. However, thedetails of how. that is accomplished are less important, and will dependon the cannulation sites. The possibility that the cannulae will beinadvertently pulled out of the patient, or that the cannulae willbecome disconnected from the pump is minimal. Either event would be acrisis. The cannulae will be sutured in place, and the pump willlikewise be secured. It could be secured to the patient's leg, waist, orshoulder, for example. It could be mounted onto the patient's bed,provided that the patient is also secured to the bed. It could bemounted on a rail or pole, which in turn is attached to the bed, as isthe patient.

Other features that need to be kept in mind are prime volume andpressure drop. It is desired to mount the pump in a holster on thepatient so that the connecting tubing can be maintained as short aspossible, thus minimizing the prime volume to about 100 cc, and keepingpressure drop as low as possible (thus maximizing flow rate). If onecannula is in the leg and one is in the neck, it will be important toprovide a means of connecting the two with a circuit as compact aspossible. So a pump placed on the leg, waist or shoulder could provide avery short path to one cannula and a long path to the other, or equalpath lengths to both cannulae. In any case, the advantage of fixing thepump in a securing and stabilizing means also allows the connectingtubing to be arranged in a compact circuit. In terms of pressure drops,it will be advantageous to minimize the negative pressure drop (veryhigh negative pressure can lead to hemolysis or cavitation in theblood), so it will usually be best to locate the pump close to thecannula which takes blood from the patient's right atrium/SVC (SuperiorVena Cava)/IVC (Interior Vena Cava) and carries it to the pump. Thelonger tubing run can then be on the outflow side, which is the positivepressure side of the pump. If femoral cannulation is used to access theRA, the pump holster and location described in U.S. Pat. No. 6,808,508,incorporated by reference herein, would work quite well.

To minimize circuit volume and pressure drop, and also to maximizepatient mobility (for bathing, changing dressings, etc.), it may beadvantageous to locate both the cannulae in the neck or the upper partof the body. The patient's shoulder can then be used as a mountinglocation for the pump. This also has the advantage of leaving the groinopen and accessible for percutaneous LVAD access, interventionalcardiology access, or other needs.

The RA cannula 14 Set includes:

1 17 or 21 Fr percutaneous RA Cannula

1 14 Fr Percutaneous RA cannula 14 Introducer

The following instruments are needed to complete the procedure andshould be supplied by the user (all the standard in art)

Introducer needle

Vessel dilator

Guidewire, super stiff, 0.035., at least 150 cm long

The insertion procedure is described below.

The PA cannula 12 Set includes:

1 17 or 21 Fr percutaneous PA Cannula

1 14 Fr Percutaneous PA cannula 12 Introducer

Insertion of PA cannula 12 is described below. Connecting of RA and PAto the pump is described below.

The invention consists of a system 10 for providing percutaneous rightventricular assistance for treatment of temporary and reversible rightheart problems. These include right ventricular infarction, rightventricular dysfunction after heart transplantation or LVADimplantation, right ventricular distention after cardiac surgery andright ventricular dysfunction resulting from left heart valve diseases.The system 10 consists of three components: 1) a cannula placed in theright atrium from a peripheral vein (femoral, jugular, subclavian); 2) ablood pump that is also a ventricular assist device, which can pump 2-4L/min with minimal blood trauma or clotting; and 3) a cannula placedinto the pulmonary artery from a peripheral vein. This cannula must beflexible enough to make the passage through the right heart to thepulmonary artery, but stiff enough to resist kinking, which wouldobstruct blood flow. The cannula must also have an end-hole and at leasttwo large side holes, which allow blood flow to the left and rightlungs, without allowing backflow into the right ventricle.

The placement of the system 10 is done as follows:

1. The PA cannula 12 is inserted first so that no interference occursfrom another cannula in the right atrium.

2. Heparin is given intravenously to maintain ACT level greater than 200seconds during the placement.

3. The right internal jugular vein is punctured with a needle andaccessed through a wire 23.

4. The skin site and vein are dilated.

5. The percutaneous PA cannula 12 and its introducer are advanced overthe wire 23 into the right atrium, which is confirmed by fluoroscopy orechocardiography,

6. The introducer and the wire 23 are removed.

7. A pulmonary wedge pressure catheter 26 is then passed through thecannula 12 and floated into the pulmonary artery.

8. A 0.035 super stiff wire is advanced through the pulmonary wedgepressure catheter.

9. The PA cannula 12 is advanced over the pulmonary wedge pressurecatheter 26 up to the inflated balloon 27.

10. The catheter 26 and the wire are removed, the balloon 27 is thendeflated once proper positioning is confirmed by fluoroscopy, leavingthe cannula in the PA.

If a Swan-Ganz catheter is already in place in the right internaljugular vein when the decision is made to place the RVAD, then theinsertion procedure changes. In this situation, the insertion of the PAcannula 12 is as follows:

1. The Swan-Ganz catheter is removed. A wire is placed through theintroducer and positioned in the PA.

2. The introducer is removed leaving the wire in the RA.

3. The percutaneous PA cannula 12 and its introducer are advanced overthe wire, into the right atrium.

4. The introducer is removed, leaving the cannula in the RA.

5. A pulmonary wedge pressure catheter is passed through the cannula andfloated in the pulmonary artery. A 0.035 super-stiff wire is advancedthrough the pulmonary wedge pressure catheter.

6. The PA cannula 12 is advanced over the Swan-Ganz catheter up to theballoon.

7. (The balloon is deflated) The Swan-Ganz catheter and the wire areremoved, leaving the cannula in the pulmonary artery.

The next step is placement of the RA cannula. This is done from aperipheral vein, such as the femoral, jugular or subclavian vein. Theprocedure is as follows:

1. The vein is punctured with a needle and accessed through a wire.

2. The skin site and the vein are dilated with a vessel dilator.

3. The RA cannula 14 with its introducer are placed into the vein andthe wire is removed.

4. A long wire 25 is passed through the RA cannula/introducer until itreaches the RA.

5. The cannula/introducer is advanced into the RA using fluoroscopicguidance.

6. The introducer and wire 25 are removed leaving the cannula 14 in theRA.

The next step is connection of the RA and PA cannula 12 to the bloodpump.

1. The RA and PA cannulas are allowed to back-bleed to remove air.

2. The RA cannula 14 is connected to the inflow part of the pump andallowed to back-bleed to fill the pump with blood and displace air.

3. The RA cannula 14 is clamped with a tubing c lamp.

4. The PA cannula 12 is then connected to the pump outlet, taking careto avoid air in the circuit.

5. Secure pump and system in place.

6. The clamp is removed from the RA cannula.

7. The pump is started at 2 L/min flow for 5 minutes and then increasedas needed, depending on the patient's needs and the specific clinicalsituation.

Several clinical points are important.

1. RV Pump flow should never be excessive in order to avoid lung injury.In most circumstances, RV pump flow should be limited to 50-75% of themeasured or estimated systemic cardiac output.

2. RV size and function should be examined with echocardiography beforeand during RV assistance to confirm RV decompression while avoidingcomplete RV collapse during assistance.

3. The position of the PA cannula 12 should be confirmed by chest x-rayor fluoroscopy at least once per day.

4. The right internal jugular vein is the preferred access site for thepercutaneous PA cannula, because it allows an optimal anatomic pathwaythrough the right heart and because it is the shortest route to the PA.Suggested Clinical Protocol for use of the TandemHeart for Right HeartSupport:

1. PA cannulation:

a. Use 18 ga. Percutaneous Entry Needle With Baseplate to access RIJ.

1. Needle: Cook BSDN-18-9.0 (18 ga by 9 cm long) Quick reorder 002401.

b. Place 0.035″.times.180 cm Guidewire through needle—advance about 15cm into RIJ—FIG. 1

2. Guidewire: Boston Scientific THSCF-35-180-15 (quick reorder 036363).

c. Remove Needle. Needle may be saved for re-use.

d. Dilate vessel with appropriate sized vessel dilator:

i. Serially dilate as appropriate using 8 Fr dilator—Dilator may besaved for re-use

3. Dilator: Daig 405512.

ii. Serially dilate as appropriate using 12 Fr Dilator—Dilator may besaved for re-use

4. Dilator: Daig 405528.

iii. Serially dilate as appropriate using 16 Fr Dilator—Dilator may besaved for re-use

5. Dilator: Daig 405544.

e. Insert 17 Fr Femoral Venous Cannula With Introducer over 0.035″Guidewire into SVC (or as far as RA)—(FIG. 2)

6. Cannula: Medtronic 96670-017.

f. Remove 0.035″ Guidewire first and then remove Introducer. Guidewiremay be saved for re-use. FIG. 3

g. Place Pulmonary Wedge Pressure Catheter through 17 Fr Cannula—inflateballoon, and advance to PA (FIG. 4)

7. PW Catheter: Medtronic 7 Fr Pulmonary Wedge Pressure Catheter#150075.

h. Place 0.035″ 180 cm Guidewire—(same Guidewire may be re-used)—through7 Fr Catheter and advance to the tip of the Pulmonary Wedge PressureCatheter. The Guidewire provides stiffness which allows the 17 FrCannula to be advanced—FIG. 5

8. Guidewire: Boston Scientific THSCF-35-180-15 (quick reorder 036363)

i. Advance 17 Fr cannula (without introducer) over Pulmonary WedgePressure Catheter/Guidewire up to balloon (FIG. 6).

j. Deflate balloon and withdraw first Guidewire and then PulmonaryWedge. Pressure Catheter, leaving 17 Fr Cannula alone in PA.

k. Cross-clamp Cannula to prevent blood loss.

1. Secure 17 Fr Cannula in place to prevent displacement out of the PA.

2. RA Cannulation:

a. Use 18 ga. Percutaneous Entry Needle With Baseplate to accessRIJ—Same Needle may be reused

9. Needle: Cook BSDN-18-9.0 (18 ga by 9 cm long) Quick reorder 002401

b. Place 0.035″.times.180 cm Guidewire through Needle (same Guidewiremay be re-used)—advance into RA

10. Guidewire: Boston Scientific THSCF-35-180-15 (quick reorder 036363).

c. Remove Needle.

d. Dilate vessel with appropriate sized vessel dilator:

i. Serially dilate as appropriate using 8 Fr dilator—Dilator may besaved for re-use

11. Dilator: Daig 405512.

ii. Serially dilate as appropriate using 12 Fr Dilator—Dilator may besaved for re-use

12. Dilator: Daig 405528.

iii. Serially dilate as appropriate using 16 Fr Dilator—Dilator may besaved for re-use

13. Dilator: Daig 405544.

e. Insert 21 Fr TandemHeart THTC with Obturator over the Guidewire intothe RA. (FIG. 7, 8)

f. Remove Guidewire first and then Obturator.

g. Cross-clamp 21 Fr Cannula to prevent blood loss.

h. Secure 21 Fr THTC in place.

3. Connect to TandemHeart Pump:

a. Connect 21 Fr Cannula to TandemHeart Pump inlet (blue stripedtubing). Locate Pump on outside of patient's leg with Pump outletpointed up toward the patient's head.

b. Prime pump by releasing cross-clamp from 21 Fr tubing and slowlyfilling and de-airing pump.

c. Connect 17 Fr cannula to TandemHeart pump outlet (red stripedtubing). Use straight connector from TandemHeart Pump Kit and additionallength of red stripe tubing as needed. Make final wet-to-wet connection,ensuring that the circuit has been completely de-aired

14. Tubing: CardiacAssist #2000-0313. Note: The pump and tubing may bepre-primed with Plasmalyte if desired to reduce patient volume loss. Ifthe circuit is pre-primed, some hematocrit reduction will occur. Theprime volume of the circuit is about 138 cc.

4. Initiate support:

a. Start pump at low speed.

b. Release cross-clamps.

c. Adjust speed to attain desired flow. Note: Caution should be takennot to over-drive the pump, which could result in excessive PA pressure.

Although the invention has been described in detail in the foregoingembodiments for the purpose of illustration, it is to be understood thatsuch detail is solely for that purpose and that variations can be madetherein by those skilled in the art without departing from the spiritand scope of the invention except as it may be described by thefollowing claims.

The invention claimed is:
 1. A closed chest system for assisting theright heart of a patient comprising: a pulmonary artery (PA) cannulaadapted for insertion into the right internal jugular vein of thepatient and to extend into the PA of the patient via an anatomicalpathway through the right heart; a percutaneous right atrium (RA)cannula adapted for insertion into a peripheral vein of the patient andto extend into the RA of the patient, so that the right ventricle of thepatient is bypassed; a blood pump comprising an inlet connected to theRA cannula and an outlet connected to the PA cannula for providing onlyright ventricular circulatory support to the patient without open heartsurgery or left ventricle support; and a controller controlling theblood pump.
 2. The closed chest system as described in claim 1, whereinthe controller is in communication with the blood pump and detects andmanages faults and produces an alert signal in response to a detectedfault.
 3. The closed chest system as described in claim 1, wherein thecontroller operates the blood pump to provide right ventricular assistof the patient at a level which is ½ to ⅔ of normal cardiac blood flowof the patient.
 4. The closed chest system as described in claim 1,wherein the blood pump is a ventricular assist pump.
 5. The closed chestsystem as described in claim 1, wherein the PA cannula has an end holeand two side holes for blood flow to the right and left lungs.
 6. Theclosed chest system as described in claim 5, wherein the end hole andside holes enable blood flow to the left and right lungs of the patientwithout allowing backflow into the right ventricle of the patient. 7.The closed chest system as described in claim 1, wherein the blood pumppumps unoxygenated blood from the RA through the RA cannula and returnsthe blood to the PA through the PA cannula.
 8. The closed chest systemas described in claim 1, wherein the peripheral vein comprises one of afemoral vein or a vein in the patient's neck or upper body.
 9. A methodfor assisting the heart of a patient comprising the steps of: insertinga pulmonary artery (PA) cannula into the right internal jugular vein ofthe patient; moving the PA cannula in the vasculature and into the PA ofthe patient via an anatomical pathway through the right heart; insertinga right atrium (RA) cannula into a peripheral vein of the patient;moving the RA cannula in the vasculature and into the RA of the patient,so that the right ventricle of the patient is bypassed; connecting theRA cannula and the PA cannula to a blood pump, with the RA cannulaconnected to an inlet of the blood pump and the PA cannula connected toan outlet of the blood pump; activating the blood pump to provide onlyright ventricular assist to the heart of the patient and without openheart surgery or left ventricle support; and controlling the blood pumpwith a controller in communication with the blood pump.
 10. The methodas described in claim 9, further comprising positioning the PA cannulain the PA using a balloon.
 11. The method as described in claim 9,wherein the inserting the PA cannula step includes passing a pulmonarywedge pressure catheter through the PA cannula, floating the catheterinto the PA, and advancing a super stiff wire through a pulmonary arteryport of a Swan-Ganz catheter.
 12. The method as described in claim 11,further comprising removing the pulmonary wedge pressure catheter andthe wire from the patient once the PA cannula is in the patient.
 13. Themethod as described in claim 9, wherein the PA cannula has an end holeand at least two side holes which allow blood flow to the left and rightlungs of the patient without allowing backflow into the right ventricleof the patient.
 14. The method as described in claim 9, furthercomprising pumping unoxygenated blood from the RA with the blood pumpthrough the RA cannula and returning the blood to the PA through the PAcannula.
 15. The method as described in claim 9, wherein the peripheralvein comprises one of a femoral vein or a vein in the patient's neck orupper body.
 16. The method as described in claim 9, wherein theinserting the RA cannula step includes inserting the RA cannula into theperipheral vein of the patient over a wire.
 17. The method as describedin claim 9, wherein the activating step includes starting 2 L/min bloodflow for at least two minutes and then adjusting the blood flow based onthe patient's requirements.
 18. The method as described in claim 9,further comprising using imaging guidance when the RA cannula and the PAcannula are in the RA and PA, respectively.
 19. The method as describedin claim 9, wherein the activating step includes the step of providingblood flow to the right and left lungs through the PA cannula.
 20. Themethod as described in claim 9, further comprising providing blood flowfrom the blood pump for right ventricular assist of the patient at alevel which is ½ to ⅔ of normal cardiac blood flow of the patient.